Combined conservative-surgical management of generalized aggressive periodontitis

A case report

Abstract

The aggressive periodontitis is a well-defined clinical entity markedly differing from the chronic form of periodontitis.
A localized and a generalized form can be distinguished. The main bacterial etiologic factor for the localized form is A. actinomycetemcomitans. It mainly starts in the first quarter of ones life. The magnitude of clinical attachment loss is not proportional to the amount of local biofilm and plaque retentive factors. The rapid, mostly vertical type of bone destruction is very characteristic. In many cases the attachment loss is localized to only a few teeth, but it may spread and progress to the generalized form, affecting practically the whole dentition. In that case a mixed Gram-negative anaerobic biofilm is present subgingivally, but the AA can also dominate the pocket flora. Its treatment is very complex and time-consuming, and needs perfect patient compliance. Predictable clinical results can only be achieved by a combined conservative-surgical therapy. The corrective phase of the comprehensive treatment and patient’s rehabilitation is crucial and mainly involves certain kind of regenerative therapy. One of the most critical phases is the supportive therapy. This can give a good chance to stop the progression of attachment loss and prevent the recurrence of the active disease.
The presented case is to demonstrate how time-consuming a 32-year-old female patient’s comprehensive periodontal therapy was, who had suffered with active aggressive periodontitis at admittance. The extensive disease control period followed by a relatively long follow-up and finished with a series of regenerative surgery could ensure a predictable outcome that might be maintained over a long period of time with regular supportive therapy.